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Anorexia nervosa
This factsheet is for people who have anorexia nervosa or for friends and family of people with anorexia nervosa.
Anorexia nervosa, often abbreviated to anorexia, is an eating disorder where people have an intense fear of putting on weight. They severely limit the amount of food they eat to reduce their body weight to an unhealthily low level. Anorexia is most common in teenage girls aged 13-19, although anyone can develop the illness at any age.
Anorexia can be treated with psychotherapy and diet advice but these are only effective if the person is ready to get better. Untreated, anorexia can lead to serious health problems.
What is anorexia?
Anorexia nervosa means 'loss of appetite for nervous reasons' but in fact you do not lose your appetite if you have anorexia, you just don't allow yourself to satisfy your appetite.
People with anorexia have a distorted notion of their body shape and image. They try to avoid or limit eating and may also over-exercise so become very underweight.
About 1 in 200 women and 1 in 2000 men get anorexia at some time in their lives. Boys and men do appear to be getting eating disorders more often.
The other main eating disorder is bulimia nervosa, which is characterised by cycles of bingeing (overeating) and purging (ridding the body of the excess food usually by vomiting or laxatives). For more information, please see the separate BUPA factsheet Bulimia nervosa. Some people with anorexia may have bingeing and purging habits too.
Bulimia nervosa
Symptoms
People with anorexia may have some or all of the following symptoms:
- a body weight which is much less than expected for their age and height
- eat very little, if at all, or restrict types of food, such as any containing fat
- be secretive about food
- avoid eating with others or cut their food into tiny pieces to look as though they have eaten some
- deny being underweight or having a problem with food
- be obsessed with exercise
- use appetite suppressants such as diet pills
- use laxatives excessively or self induce vomiting
Health problems caused by anorexia
Apart from weight loss, the physical signs of starvation can include:
- absent periods in a woman who is not pregnant or taking the contraceptive pill (missing at least three consecutive periods)
- delayed puberty in girls since anorexia affects hormones
- for men or boys, a loss of sexual interest and potency, or delayed puberty
- thinning hair on the head
- fine, downy hair on the body and face
- feeling cold all the time
- difficulty sleeping
- constipation and abdominal pain
- fainting spells, low blood pressure and a slow heartbeat
- tiredness with aching muscles
- difficulty concentrating
If a person with anorexia vomits after they've eaten, they may have other problems such as discoloured teeth, bad breath and heartburn.
Over time, anorexia can cause serious long-term health problems such as:
- osteoporosis (brittle bones that break easily)
- damage to the heart
- infertility
If people with severe anorexia do not receive appropriate treatment, they may die from related health problems.
Causes
The cause of anorexia isn't fully understood at present. It may develop due to a combination of emotional, physical and social triggers. The precise reasons for developing it are thought to be different for each person.
Certain personality traits are common in people with eating disorders, which include:
- low self-esteem
- perfectionism
- a need to please others
- mood problems, especially depression
- mental health problems such as disruptive rituals - for more information please see the separate BUPA factsheet, Obsessive-compulsive disorder.
An eating disorder may bring a sense of control and achievement to certain people with these personality traits.
There are certain factors that may make a person more likely to develop anorexia including the following:
- eating disorders are more common in white people in western societies and rare in developing populations. Some people believe that media images of thinness may have some influence on eating disorders
- people with type 1 diabetes are more likely to develop anorexia
- dieting can increase the risk of developing anorexia in some people
- particular professions or sports where a very lean body-type is desirable may also indirectly encourage anorexia, for example, running, gymnastics and ballet
- people whose mother or sister have an eating disorder are more likely to develop one, although it is not clear whether this is due to genetic factors or the learning of certain behaviours
- a specific emotionally upsetting event, such as divorce, bereavement or abusive family relationships may trigger anorexia
Diagnosis
Getting help is very important. For people with anorexia, admitting that they have a problem is the first, yet hardest, step. If they take that step, they can find the support and treatment they need to stop anorexia taking over their lives.
A GP is the first point of contact for help. He or she will ask about the patient's life and eating habits and will examine them to check for any physical problems resulting from anorexia. He or she may refer the patient to a psychiatrist or psychologist who is trained in treating people with eating disorders.
Treatment
A person with anorexia can be helped much more easily if the problem is identified and treated early. However, for treatment to be successful, he or she must be ready to get better.
The aim of treatment is to re-establish a healthy attitude towards food and a consistent pattern of eating, with three meals a day at regular times.
Healthy eating
Keeping a diary of eating habits to discuss with a GP and learning about healthy eating and sensible weight control may be helpful. For more information about maintaining a healthy diet, see the separate BUPA factsheet:
Healthy eating
Drug treatments
There are no drugs that can cure anorexia. Some people need medicines to treat other health problems caused by anorexia, such as oestrogen hormone supplements in adults if their bones are weak because of anorexia.
Talking treatments
A type of talking treatment, or psychotherapy, called cognitive behavioural therapy (CBT) is frequently used. CBT allows people to talk through the issues that upset them and that may lie at the heart of their eating disorder. CBT can help people to learn healthier ways of thinking about food. For more information about CBT, please see the separate BUPA factsheet:
Cognitive behavioural therapy
Self-help groups may also be helpful. It is often comforting to talk to other people who have been through the same thing, and who can offer understanding and acceptance without blame or guilt.
Therapy involving the family may also be helpful, especially when a younger child has anorexia. This helps everyone in the family to support each other.
Hospital treatment
Most people who have anorexia can be successfully treated without being admitted to hospital. However, if excessive weight loss has put someone's life at risk, hospital may be considered for fluid and other nutrient replacement.
Compulsory treatment is always a last resort, because it is distressing for people with anorexia to lose control over what they eat and drink.
How can family and friends help?
It can be upsetting to witness loved ones putting their health at risk and it is natural to want to help. But unwanted pressure or criticism from others usually makes matters worse.
Try to let the person make his or her own choices and let the person know that love and support is consistently there. Once the person has recognised the problem, offer to help with practical matters such as finding medical assistance, self-help groups and other resources that may be needed to help them get over anorexia.
Recovering from anorexia
It is possible to recover from anorexia, although it can be a long process. People may have relapses in times of stress.
Anorexia is difficult to overcome, but with commitment, patience and support it can be done.
Further information
References
- PRODIGY Guidance - Eating disorders. UK Department of Health. PRODIGY.
www.prodigy.nhs.uk
accessed 22 August 2005
- Anorexia and bulimia. The Royal College of Psychiatrists.
www.rcpsych.ac.uk
accessed 25 August 2005
- Eating disorders in the UK: policies for service development and training. Report from the Eating Disorders Special Interest Group of The Royal College of Psychiatrists. October 2000, Council Report CR87.
www.rcpsych.ac.uk
- World Health Organisation (WHO). The ICD-10 Classification of Mental and Behavioural Disorders - Diagnostic criteria for research. Switzerland: WHO, 1993.
- Collier J, Longmore M, Scally P. Oxford Handbook of Clinical Specialities. 6th edition. Oxford: Oxford University Press, 2003.
- What is anorexia nervosa? The Eating Disorders Association.
www.edauk.com
accessed 22 August 2005
- Anorexia nervosa. Clinical Evidence.
www.clinicalevidence.com
accessed 22 August 2005
- Eating Disorders - core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. National Institute of Clinical Excellence (NICE). January 2004. Clinical Guideline 9.
www.nice.org.uk
Reviewed by Dr Adrian Winbow, MB, FRCPysch, DPM, consultant psychiatrist, Godden Green Clinic, Godden Green, BUPA Hartswood Hospital and BUPA Hospital Tunbridge Wells.
Published by BUPA's health information team, healthinfo@bupa.com, October 2005
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